Effective team communication is a key ingredient of safe care. It is essential for preventing medical injuries and responding to injuries that take place. When medical injuries do occur, open communication between healthcare providers and the patient, including compensation when appropriate, is a moral imperative. Yet open communication is the exception not the norm. Washington State provides a unique environment for improving healthcare communication, including a statewide infrastructure for quality of care data sharing in a protected setting that feeds a peer-led approach to system change;national leaders on patient safety and quality improvement;and Physicians Insurance, which insurers over half the state's physicians. Therefore, with the support of Governor Christine Gregoire, U.S. Senators Patty Murray and Maria Cantwell, Physicians Insurance, and key state stakeholders, we propose a demonstration project with the following specific aims: 1. To create a multi-stakeholder collaborative across Washington State to enhance communication to prevent and respond to medical injuries. 2. To implement intensive communication training to prevent and respond to medical injuries at 10 partner healthcare institutions. 3. To develop and evaluate a collaborative approach to adverse event analysis, disclosure, and compensation between 5 of these 10 partner healthcare institutions and Physicians Insurance. 4. To disseminate the communication training statewide via interactive e-learning modules and assess its impact on patient safety and malpractice liability. After stakeholder meetings, we will partner with 10 healthcare institutions on tracking communication-sensitive events (CSEs) by creating a new module within the Surgical Clinical Outcomes Assessment program (SCOAP) that will measure CSEs (NQF Never Events, Medication Errors, Checklist Failures). Using these data, we will provide customized communication training for physicians, nurses, and pharmacists to prevent medical injuries (TeamSTEPPS), advanced conflict resolution) and to communicate with patients after medical injuries. The training's effectiveness will be assessed with a pre-post Web based assessment. We will also measure the training's impact on communication-sensitive events. In addition, Physicians Insurance and five partner healthcare institutions will implement an innovative approach to joint adverse event analysis, disclosure, and compensation for patients in a multi-institution, multi-insurer setting. Finally, the communication training will be disseminated state-wide via engaging e-learning modules. Our team includes national leaders in patient safety communication (Thomas Gallagher, MD), Quality Improvement (David Flum, MD, MPH), Team Communication (Brian Ross, MD, PhD), Malpractice Claims (Michelle Mello, PhD, JD);Interprofessional Collaboration (Brenda Zierler, PhD, RN), and Evaluation (Douglas Brock, PhD, Beth Devine, PhD, MBA, PharmD). PUBLIC HEALTH RELEVANCE: Effective team communication is a key ingredient of safe, high quality health care. Yet such an open communication, especially around adverse events and errors, is the exception rather than the norm, as is the provision of fast and fair compensation to patients. We propose to create a statewide initiative involving communication training of healthcare workers and a collaborative with hospitals and a malpractice insurer to improve adverse event analysis, disclosure, and compensation, in order to enhance the culture of healthcare communication to improve patient safety and decrease medical malpractice liability.